Monday 28 December 2009

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Health Report 29 min 1 speaker 8 chapters transcribed 4 days ago

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Transcript generated automatically by AI and may contain errors.

Why is low‑back pain such a common health problem and what are the basic treatment options?

Norman Swann 0:00

Hello, and welcome to the Health Report with me Norman Swan. Today a part of the body that's been a pain or will be a pain to most of us at some time in our lives, our backs. There's a huge industry out there devoted to the bad back from chiropractic to physiotherapy to acupuncture to surgery, and you can be sure that when there's such a variety of things on offer in medicine, there's no magic answer. The evidence is that for common or garden low back pain, not lying down to it if that's possible, and perhaps some targeted muscle strengthening is pretty good in the long run. But for some people with really bad nerve pain, sciatica, or a condition that's called spinostenosis, and I'll explain what that is later, the option of back surgery emerges, and it's controversial for a lot of reasons.

Norman Swann 0:47

Some trials show benefits in carefully selected people, some don't. And in any event you can imagine how hard it is to do a randomized trial of something like spinal surgery. Secondly, there's an epidemic of spinal surgery, at least in the United States, with it being one of the most rapidly growing types of operation. The situation in Australia isn't so clear, but there is a lot of spinal surgery around, and hospital costs for chronic back pain and slip discs are around five hundred million dollars a year. But it's patchy and varies from place to place. And when there's variation in surgical rates, it rings alarm bells among people who care about safety and quality in healthcare. Because too much or too little surgery might be going on, or might be being performed on the wrong people.

Norman Swann 1:33

And thirdly, in terms of the controversy, there's new technology emerging all the time for spine surgery. Spine surgeons, like other subspecialist surgeons, have a tendency to invent their own instrumentation, and there are new bolts, plates, and other kits appearing on the market all the time, sometimes without sufficient safety information. And then there are also new operative techniques which surgeons will argue about endlessly, not to mention that there are two surgical specialties involved neurosurgery and orthopedics. So what's the poor consumer to think, ask or decide if he or she feels she might need an operation? One of the options in spinal surgery is to have a minimally invasive operation of some kind.

Norman Swann 2:17

And that's what Maggie Scott chose to have, but went overseas to have it done. Maggie is one of the pioneers of dance in Australia. She founded the Australian Ballet School. and has been a prime mover behind the Australian ballet, and many of Australia's leading dancers have been trained by her. But back to Maggie's back, because it started to give her major trouble early in her career.

Maggie Scott 2:39

When I came out here with a ballerombe in nineteen forty seven, I had a back problem then. It ended up in St Vincent's in Sydney. They put me in a plaster spiker from under my armpits to my ankles for six months.

Norman Swann 2:51

The old fashioned treatment.

Maggie Scott 2:52

The old fashioned treatment of non movement. And then at the end of it they took me out and did a sort of laminectomy. And I went back to dancing again and about six or eight months later it all happened again and I ended up for another five months in the Alfred Hospital in Melbourne and had a fusion of two vertebrae. So that was way back. That was really beginning.

Norman Swann 3:11

So you've been punishing your spine or your spine's been punishing you for a long, long time. For

Maggie Scott 3:15

a long, long time. And

Norman Swann 3:16

did that end your dancing career?

Maggie Scott 3:17

It limited it, yes.

Norman Swann 3:19

Maggie Scott mentioned two operations you'll hear more about. A laminectomy refers to removing a piece of the bone surrounding the spinal canal to either widen it or relieve pressure on a bulging disc, or indeed remove the disc. In the olden days, the ones Maggie's talking about, a laminectomy was usually a much bigger operation than it is today, and involved removing a lot more than just this lamina bone. So much so that the surgery could create instability and the person ended up needing a fusion operation to hold the vertebrae together.